Nov 11, 2012|
The Roswell team takes calls on breast cancer.
The Roswell team discusses women in research; mentoring the next generation.
A Roswell physician discusses Melanoma and Immunotherapies.
March is colorectal cancer awareness month. The Roswell team discusses screening options.
The Roswell Park Team and a family member discuss "The Healing Touch" Pilot Program
Automatically Generated Transcript (may not be 100% accurate)
-- This is Roswell. Rookie by Roswell Park Cancer Institute. Your team opinion or your total options. Your host him -- and welcome back to Roswell is a comprehensive look at all aspects of cancer care treatment diagnosis and research. From a comprehensive source Roswell Park Cancer Institute he. In Buffalo, New York. I'm Tim Wenger in this time on the program we dipped into our two hour breast cancer special that aired during Breast Cancer Awareness Month. And on the program I was joined by doctor air Melinda -- not geo director of the Roswell mammography center. Doctor Steven had a breast cancer medical director and chief of breast surgery at Roswell. Doctor James Marshall senior vice president for cancer prevention and population sciences. And doctor -- day assistant professor of oncology in Roswell -- department of radiation medicine you're on W the end with the Roswell experts. He had and I don't -- actors featured actor. In eighty happens I can't answer. That -- what it what it did start with a lot. It started with his chair. I chilled to perform the -- people. Don't Yankee yeah. Be kind of democracy. I or I did what I'm I had cancer in their -- -- ball hard and I chose me or -- procedure done it's called a procurement flap. Which doctor Adams did very well and that I'm just -- you wouldn't -- Get -- Wimbledon finally and truly change at all it doesn't get could be a lot of an epic epic and I acknowledged. There's salute to better and I just on the -- -- and thirteen years later I'm here I'm doing well. Well it's great to hear from you. The the fact of course is is that lumps are not the only thing. In fact most missed most breast cancers are no longer from a -- their found by a mammogram. But in addition of a discharged from the nipple Camby the sign of an early breast cancer. Especially if that is bloody and blood means either red blood or. Dark period dark brown fluid it's as true that's. Blood that -- in the in the dark because it's no longer in the bloodstream and then it comes up to -- black or brown. Material dark -- Russian -- comment. Just exactly what you said I'm discharge from one brass especially big -- talent coming from one doctor especially if it's coming down on its own it doesn't involve you trying to express that at all is concerning as you well know. And typically one he. We will start with a mammogram to take a look at the fasten their other tests that we can also -- to evaluate it but it's. A one of the signs that should bring a woman to her position for further evaluation. All right we now move on that and by the way march thank you so much for the phone call appreciate -- today we're gonna stay in Amherst this is Bonnie I'm WB and I Bonnie. Crying mama you wondering if either you study being done. Correlates bomb breast cancer with -- abortion and not -- and fertility treatments. Doctor marshall's gonna tackle that -- -- they're there were some early studies linking. Abortion to breast cancer risk. Those have pretty much come -- no. It's been known for some time that women with lower. Fertility who have had fewer children or who have their children late aren't somewhat higher risk. But. What that means probably is that people should be screened more carefully if they've. If there -- no licorice or if they've had their first child after the age forty. -- -- The from early studies suggested that kaposi's might increased risk by the larger ones. Have not shown that. Ended dose of of drug in the breast cancer pills that are being used answering the the for contraceptives that are being used -- are much lower. And apparently do not increase the risk of breast cancer. Are very much. OK Bonnie thanks for the phone call doctor may. You know we hear so much about the you know mastectomies and in chemotherapy how how often and how much he's radiation used in in -- And breast cancer thank you very much that question it's it's used very frequently it -- the other half of treatment and breast conserving therapy which includes a smaller surgery. Also known -- than what local decision a partial mastectomy or lumpectomy. They generally for trinity smaller surgery. It allows woman to keep her breast so the smaller surgery is done and the other half of that treatment. Is actually radiation directed at the press or the surgical site. And then notes when indicated. That is a part that is standard treatment for early stage breast cancers. For more advanced breast cancers are for women who had a mastectomy by choice or by necessity. Radiation plays a very important role for those woman as well as they have higher risk features that would include -- tumors tumors that involved the skin. Tumors that have significant nodal involvement is well and the role of radiation is markedly reduce the risk of that breast cancer returning where once. It also comes with a survival benefit which is what we are all hoping to improve upon in my all of our efforts are directed towards. Radiation also pleasing -- critical role in valuation of symptoms and namely pain. And so throughout the spectrum of breast cancers there's often a very clear room for radiation as well. You announced thoughts on that. Okay we're gonna move on right now to Geneen. -- your NW the end. -- -- Could go -- your question for the experts here. Okay well I didn't think -- -- and I just finished my last chemo treatment for breast cancer I was I was diagnosed and April and so now I'm on to the next stage which is an accident it's not that different ideas and I requested that the -- is added to fold up my first question is in regards to what your recommendation is to plan. Yeah I -- if I am and at this point in treatment and then you're given the actions to have your ovaries removed or not. The that that's a great question. -- mobile manipulation of breast cancers has been something that's been around -- for almost a hundred years now. And part of the development of the anti estrogen drugs. In the 1960s. Removing the ovaries in women who have not yet gone through menopause in young woman such yourself. Was a dramatically effective. In women with advanced cancers and in fact in women like yourself who -- otherwise completed treatment for breast cancer. It's largely been replaced now by the anti estrogen pills the most widely abused do which is Tamoxifen Tamoxifen is the only one that's really effective and pre menopausal woman. Others have drug which replaced for postmenopausal women it doesn't work in pre menopausal woman for a variety of reasons. On adding remove the ovaries in terms of treatment for breast cancer as well as nothing. To your care the question about ovarian over removal does have to do with the genetics of breast cancer. Do you have a family history of breast cancer. Yes but I'm headed sixteen acres got -- So your -- presumably somewhere on the age of 45 or fifty when you have breast cancer and -- familiar with that but. -- last sixty. Or yeah. So. So that raises the question of inherited changes within the family and and with few minutes 37 we would talk to about the potential for genetic testing for the RCA mutations did you have that done. I dead and that came back. Okay so there's -- the issue there is that theorist people who that we are seeing mutation are not only at risk for breast cancer putter is higher risk of getting ovarian cancer. The best evidence for that reason we recommend those women when they're finished having their children have their ovaries removed if they have such mutation. The best evidence is that women who have a strong family history but do not have a mutation. Or alteration of the PRC one or BRC two genes are not at increased the risk for ovarian cancer and there really is no particular value to having the orders removed. It is a surgical procedure that carries some risk with it and it doesn't. I guess -- -- that I was given about it is essentially you know that's the source Sebastien productions so if you just. Tibet source about that you don't need to take it with a -- for the cancer. Yes but you take the Tamoxifen and affect the data shows that you get the benefit from Tamoxifen and removing the horrors does not add anything to taking Tamoxifen. And testing impact that was my questions -- houses and then he also said you know if you don't wanna go so far as having me over Internet. They have that option now. Where they can give you a shot every month. That would essentially. You'd think being as you know -- -- operated as opposed to having commandos. Yes but that doesn't necessarily improve the long term chances of being free of spread of breast cancer. Compared to taking Tamoxifen people are actually -- have been studying this trying to say well can we use the new class of drugs which requires few overs to not be working. Along with the along with shutting down the ovaries and those studies have not really shown that there's any particular advantage to taking too much. -- -- -- That -- I think and it -- a second question. With the guys and maybe -- Eighteen to mean hang on just a second OK doctor Marshall has something at least to this point here your congress I'll defer to doctorate from this spirit. Making a person. Taking away -- person for ovarian. Activity completely. Is not without risks itself. Right right it makes a person personal permanently postmenopausal and has effects in terms of bone density and other factors -- it's -- to any one final question you've got. Yeah yeah and then what your thoughts are about diet you know I've been. As told to kind of stay away from eating -- way. And then it you know -- you say that that's that's very adamant opposition to -- and dairy are there other things he would say. You know I don't need that do that or. -- for that matter as supplements your diet like vitamin. We have been looking at this. For a long time. And they're the the best we can glean from from our studies. Is that there is nothing harmful about consuming sort products. And there's no point in staying away from dairy products the thing you have to look out for his obesity. That's that's what's most important. Which women listening out there should absolutely. Without doubt the making sure -- screened for breast cancer. So any woman over the age of forty should be having an annual mammogram. As we've said before earlier today in and optimal say if this is the one test that has been actually shown. To decrease the risk of dying from breast cancer. And if you are at higher risk in this is accomplices. Higher risk for breast cancer. Have a family history of strong family it's your breast cancer in women -- and you family who are young when they were diagnosed with breast cancer you. Know you have the -- -- On. You should probably start screening earlier and in addition. Women at very high risk of breast cancer it will often in. Not only mammogram but -- breast MRI. But. Both women need to. Do that in setting -- conversation with their positions or in -- of -- I was breast clinic which we do have that Roswell. Where. Will keep coming and fast you -- and and then -- what other appropriate interventions. -- recommend it great thank you let's go way -- to war son now Marco you're on WB and with the experts from Roswell park. -- either. I had they -- -- give me two years ago. It -- these kids so why not these followed by a man come. I had to blunt it would be legally I think I can of these -- about. I. Right now 84. It was followed -- to win I hit it hit the game and -- -- regularly have because they also have also. Non hodgkin's lymphoma -- and that it was a good at it that -- cat scans. That that was an area of concern that night he needed to be up -- and then it was looked at people as. Got like that he was not a lot but Italy off. And then of course we. Mastectomy. Radiation follow up. Attribute is its -- wish -- I cannot say. I can't ask -- -- is -- -- it and so obviously I had some bulls lead over what they have. How did that because deep into this should I have head. I didn't know that ever -- relationship between this and that didn't but I can't stuff. Should I have hit them I -- -- there's been a mammoth problem. Tape -- -- is gonna handle the story Margot through. You bring up some really interesting and important points. One of the important points you bring up is. Highlights the need for continued to search. The fact is that mammography has talked to about two or just that's been demonstrated to reduce the camp chants were. Women die of breast cancer so we'll have large populations of women population -- -- states they should have tomography. You highlight the point of demography is not a perfect technology and does not factor for breast cancer. Period we we know that. To many people who public that's surprising but we know limitation of the study and it's it's unfortunate and something where we need to focus -- search. The issue of women who have voted Ashkenazi Jewish descent Ashkenazi Jewish descent largely refers to people of who came from Eastern Europe. May have hit are little more likely to have an alteration in one of these breast cancer related genes the PRC one and two genes. Those are typically related to breast cancer at a younger age not in your early eighties. About 2% of women of -- Russian Jewish ancestry. Have a mutation. In the PRC one or BRC a two genes. So if there's particularly -- family history and a Jewish family. That's something that should clearly be considered actually. If you came to us at age 79 for your five years ago and said. I'm of Ashkenazi descent is there anything I should be doing other -- other than a martyr feet. We would have said no that's all you need to be doing at -- -- we would have nodded grumble about testing for you. Your family may wanna consider this issue and talk with the genetics or counselor. Regarding this issue in terms of their risk in the future but you are piloting some of the limitations of our technologies and why we need to continue do -- research moving forward. Terry Margo thank you very much for the call and doctor gonna treat pets and comments to I decided to follow up on. And demography is that the test but this doctor and decide it does not find out breast cancer is. So I think it's important to note that if you do feel a lump if you notice -- change in your -- even if you had your mammogram yesterday. He still need to bring that to your physician's attention you probably need additional tests. -- in -- of one -- -- WVM with the Roswell experts. Colonel I -- when they went -- last thing it is to have a bit dedication and and care followed the rest of workers where we're blessed in this area you don't agree. And -- -- -- documentary we're on an alarming number of -- We're getting breast cancer who were getting chickens com feed with hormones and and natural -- swear by. I'm I'm wondering how do do we know -- trying to link is between hormones in food and water. And approximately what percentage of breast cancers are estrogen dependent. We're all looking at doctor Marshall here I can't tell you the percentage of breast cancers that are estrogen dependent we've that's my colleagues. But there is really no direct evidence. At all. That so hormones in chicken feed our risk factor for male we're female breast cancer. Well that's -- Jim you know there's must be many many environmental factors that we simply don't know about. Many things about our society. Again -- Underscore the we have no weapons I've never heard and evidence it's hormones and chicken feed it to the male or female breast cancer they're missing many many things in our society. That lead to people having higher risk are breast cancer risk is very different north American society -- westernized society and her decision societies and when those people moved to north American society -- is physically adopt the breast cancer risk of a North American side. There are probably a number of characteristics of our lives we're very fluent. We tend to be overweight. We tend not to exercise great field because we don't have to. So we are very very comfortable and there are some things about that it probably increase our risk we don't really know what they are there are few identifiable risks. -- quick mention of obesity. Alcohol consumption. Lack of physical activities from -- factors that we're going to look at. And in addition. There is increasing evidence that tobacco. While it's not a risk factor for breast cancer -- day. People who develop breast cancer who smoke do worse. So go -- other part of her question was some. What percentage are estrogen dependent. A 70% of breast cancers express what's called the estrogen receptor. That has nothing to do with whether estrogen caused their breast cancer and that I think that's what people refer to other estrogen dependent all the pertains to is that. Those breast cancers may be treated by anti estrogen drugs that may reduce the chance of -- developing -- disease so about a 70% are estrogen receptor positive. This has nothing to do what caused the Christmas. Harry Polly thank you very much and let's go through Niagara Falls and say how to Linda -- bigger and WB ENN. Hi I'm imitation of Roswell and I was diagnosed in 2007 with breast cancer. And I was found several studies here Roswell although one that concerns me the most is feet. By -- study that I was -- because after reading -- recent information. In the news. I'm in regards to on this side effects long term -- it struck. The public I am experiencing and have reported to the position that -- well. But also now that you hear they. Evidence does. The bone cancer. You know after being metastasized. After being about cancer survivor. It's hard to differentiate is that the pain is caused by dad or possibly spread of the disease at camp itself. A great question distrust and -- are drugs that help book. That that affect the -- and disposition in the bone. That are widely used to help prevent osteoporosis there are some very uncommon. Side effects routed through here than usual femur fractures. The interesting thing that was found. With a number of studies that were done in Europe -- -- the United States was that women who took. This -- and drugs along with other anti cancer treatment. -- lower risk of developing spread of breast cancer so in fact the chance of developing bone metastasis was observed to be lower. That led to a large scale study of distrust events in the United States to see whether. This was actually true or whether that was. An observation that was really backed up defeated. Very well designed researched that so that's what that study is very interest in drugs. They do have some. Serious move those serious side effects are really quite uncommon but you bring up some really important. Points about it about that an -- underscore the need why we really do do do these carefully designed research studies to not only to find the effectiveness of drugs. -- learn as much as we can about their side effects. Okay learned a good luck with your treatment of does that answer your question Monday. -- much. All right thank you for the call today appreciate that and let's go to buffalo now this is Denise hey Denise here on WB ENN. Hi Gloria good. -- thank you doctor straight time. I'm like it's a question about screening. I have filed by the district -- no history of breast cancer Mike Stanley but I often they have annual mammogram. But often has hit several films taken my -- -- should it be also getting a sonogram. At this point on is that so. Wit I'm it is very common for women with. Barbara cystic changed to need -- off to someone they get a mammogram. I'm typically. We make that decision. Based on on how the mammogram looks if there has been any interval change on you more likely to have a new month that we see on the mammogram and then -- Next step is to determine if that's another. Fist and to do an ultrasound. Will on will. Will answer that question. Whether you should get an annual ultrasound in addition to the mammogram. Is. It is is somewhat controversial. There have been some studies with in women that have a higher risk for breast cancer -- not anomalous for breast cancer. But if you do and and had dense breasts serve which often goes along -- -- change. That they. Can find additional cancers. On that we don't see on the -- court. The problem is that we find a lot of the ninth things also that -- apart a biopsy. Two -- to determine whether it's cancer -- not so that's. You add to their risk of having a false positive. So there isn't. -- recommendation for everyone what we encourage people to do is talk to their decision and about whether that would be appropriate -- but there is definitely. And also it's important to know that there's no data to show that adding that ultrasound actually decrease your risk of breast cancer we don't really know if there is a mortality benefit to. What about increase treaty and would it increase your risk if they're doing -- man programming on the program. There's no radiation involved with ultrasound sell you on the only radiation you -- with the mammogram and that's a very low depth. Thank you carried that Denise thank you very much you know speaking of radiation and doctor may there is that concern people have the concern that radiation. You know -- it is doing the good it's you know may be harming us if you can comment on this because I know it's come a long way. I think you need to consider the type of radiation and we're surrounded I've read each and every day lives. And particularly in some -- found the the greater rate on is actually quite high at the former treaties well you the latest radiation. If you travel on long airline flights are getting significant. Forms of radiation actually the airlines plane itself typically contribute more radiation dose and the screening and there's been a lot of discussion about the year airport screening. From a therapeutic standpoint the radiation doses were talking matter clearly being John -- specific reason. There's been a lot of focus on. Diagnostic testing and cumulative lifetime doses of radiation. It's obvious that if you needed -- and you have a specific reason to do that and that test should be done. If there are reasons why tests are not necessary. And obviously in unneeded tests as an immediate past. From our radiation standpoint therapeutic radiation has changed markedly and is different than diagnostic radiation. Most of the exposures actually come from the environment and then also agnostic testing. When it's appropriately indicated. I would think that the benefits far outweigh any any concerns -- if you. I think the answer with demography is straightforward the benefits far outweigh any concerns but I think to doctor -- point that certain tasks that have higher radiation does such as CT. We have to utilized carefully and if it's -- necessary tasks than it far outweighs them. Com the risks but we we do you have to be careful about the indication CUNY -- WB EN. Up to be all right what would you consider. Fanatic. Early breast cancer because you're the -- it breast cancer. Is diagnosed probably twenty here gosh diet that it's here at the ball and it is that it's not pregnant -- that there aren't more after that the that the story wouldn't it but it. And I don't said the country all the apps that if they. It was not as they're out though because -- barely history because the little eight did you ever expect nobody else all they're really. We know it it's all day and that's. Ball well and see what it was considered fanatic that's. So you have -- you have breast cancer so. I've never had acknowledge whether -- only -- in our whole entire family. And she was an early fifties. So so no one can say for any individual whether it's clear inherited changer now. It's a matter probabilities. The probability that. It is a definable changed that inherited family. In a woman who has breast cancer issue to six and that's the only breast cancer of the family is very low. And therefore that does not -- gene testing with for the genes that we can discover. But the flip side of that is. We don't know everything there is to know about breast cancer. -- there must be other environmental societal and genetic influences on. So that's what you're getting I think conflicting two ways that people are saying this but it's about it in each of the real question is what is this something for you to do now. Terms of gene testing for women whose only family history is that her mother had breast cancer and postmenopausal years. It really affects her -- breast cancer risk of at all on a population. Basis in other words of the chance that. You for the whole population of people. The risk that for you that your mother her breast -- 56 and that barely changes your risk at all that doesn't mean that there won't be a few people who are identified to have gene mutations if we tested everybody what's the matter probability is. And what should you do now we would not be recommending that you do for genetic testing. Based on the what you -- over the phone that does that help. Yet really doesn't want without question they do Medicare Franken has breast cancer who went to the -- Eric can you explain what former therapy is in intriguing you know breast cancer and it went to the -- what do -- what is exposed to Dilfer. Up patients. For woman who has an estrogen receptive breast cancer estrogen receptor positive breast cancer anti estrogen hormone agents. Stoppers or stop the -- against cancer group or kill the cancer cells and prolong survival. The doctors from Roswell park doctor air Melinda did not geo director of the Roswell mammography center doctor Stephen -- Breast cancer medical director and chief of breast surgery at Roswell. Doctor James Marshall senior vice president for cancer prevention and population sciences. And doctor Killian may assistant professor of oncology in Roswell -- department of radiation medicine part of our. Two hour breast cancer special with the experts from Roswell park that is Roswell -- if you'd like to call Roswell anytime told free. It's 877. Ask our PCI that's 8772757724. Or visit their website in -- are. Listen to Roswell this Sunday mornings at 630 young WB yeah. Rocky by Roswell Park Cancer Institute your team opinion for your total options on line at Roswell this god of war. -- And hanging do you know. Then.